Guest column: Pregnancy, narcotics exact huge toll

Last year, 855 infants spent their first few days, weeks or even months of life in agonizing withdrawal from prescription or nonprescription drugs because their mothers exposed them to narcotics during pregnancy. This dangerous and costly disease has been termed Neonatal Abstinence Syndrome (NAS). Tennessee has one of the highest rates of NAS by population of any state, a rate that has more than tripled in the past eight years into a statewide epidemic.

The Tennessee Medical Association has pushed for solutions because narcotics addiction — in babies or adults — is a disease that cries for medical intervention. Pregnant women who are addicted have high-risk deliveries, and babies born with NAS have complicated medical issues that require prolonged treatment, usually in a hospital setting.

Science has not yet given us clear answers on the type and amount of medications to administer to mothers before delivery to mitigate NAS, but one thing is clear: We want the best care for the mother and the infant.

This is why the Tennessee Medical Association advocated for passage of the Safe Harbor Act in 2013. The bill, which is now state law, was lauded nationally as a model for dealing with NAS. It states that if an expectant mother seeks treatment for her drug use by week 20 of her pregnancy and remains in prenatal care with a drug treatment program through the term of her pregnancy, then the state Department of Children’s Services cannot take custody of her baby solely because she took narcotics while pregnant.

We can’t say yet whether the Safe Harbor Act is yielding results in the fight against NAS, but the intent was to give women an incentive to submit for prenatal care, and to eliminate fear, so they can feel free to discuss their narcotic addiction with their personal physician.

What we do know is that NAS affects more than mothers and babies. The average cost to the TennCare program for an infant born dependent on drugs and diagnosed with NAS is nearly $67,000, approximately 16 times the $4,237 cost to taxpayers for a healthy delivery.

State officials take notice of a problem that adds more than $53 million annually to an already strained Medicaid budget, so the General Assembly attempted to address the problem by passing a new law this year (SB 1391/HB 1295). It takes the opposite approach of the Safe Harbor Act by giving district attorneys and law enforcement officials the authority to prosecute women who are caught using drugs while pregnant on an assault charge if their babies are born dependent on drugs. It is the first law of its kind in the United States.

Proponents maintain that the new law enables women to get affordable treatment for drug problems through the courts that they could not or would not pursue on their own. The Tennessee Medical Association opposed the bill, and advocated successfully for two important modifications.

First, a woman can only be charged with a misdemeanor and not a felony, as the bill was originally drafted. This is important because the lesser simple assault charge is enough to get women into drug court and, if they successfully complete approved treatment programs, their cases could potentially be resolved by judicial deferment of prosecution or placement in a pretrial diversion program. A much more serious felony charge would attach an even higher criminal stigma to this medical problem, and cause other issues for the mother, such as her ability to earn employment.

We hope women will not be deterred from seeking appropriate care because of this piece of the law. Tennessee physicians like me remain concerned, however, that the new law will have unintended consequences. If misinformed mothers do not seek prenatal care for fear of prosecution or losing their babies, then an already dreadful situation will worsen.

The other important amendment to the new law was a “sunset” provision specifying that it will be in effect for only two years — until July 2016. This gives us enough time to gather data we need to evaluate whether it is improving the situation, having no effect or making it worse.

Right or wrong, at least we are doing something in Tennessee to try to deal with NAS. These laws passed during the past two years, along with the new Controlled Substance Monitoring Database website, are the first of their kind. The state is producing for its website a list of doctors and facilities that provide drug treatment, and officials are planning to disseminate more information soon to health care providers and prospective mothers.

We need to educate women about the danger of using narcotics while pregnant to prevent NAS cases. We need to closely monitor our new laws and develop better programs if we cannot demonstrate a measurable reduction in the NAS epidemic.

The Tennessee Medical Association strongly believes that the best option for women addicted to narcotics and the best protection for innocent babies is appropriate medical treatment, and a healthy, trusting relationship with their personal physician.

Douglas Springer, M.D., of Kingsport, is president of the Tennessee Medical Association.